President Bush calls him "Fristy," but to Senate colleagues, he's Dr. Bill Frist - the first physician in the Senate in nearly 75 years. Monday, he'll be chosen the majority leader by the 51-member Republican caucus, and it's all but certain to be unanimous.
It's one of the most unlikely rises to power in Senate history. A pioneer of heart and lung transplants, the surgeon from Nashville had never registered to vote until a few years before he campaigned for his first elective office - to the US Senate.
Frist has close ties to both the Bush White House and the healthcare industry - ties that are seen by colleagues as both strengths and liabilities.
Fiercely energetic, the surgeon senator still skips a night of sleep each week, colleagues say - a throwback to his habits during a medical career that included more than 200 organ transplants and 100 peer- reviewed articles. In his spare time, he flies his own plane, runs marathons, writes books (four), and advises patients in poor Washington neighborhoods. On vacation, he operates on AIDS patients in Africa.
By his second term in a Senate often cool to the ambitions of newcomers, he'd stamped his name on signature health issues, from Medicare reform and a patients' bill of rights to human cloning. His ties to the new Bush White House enhanced that influence. And when GOP leader Trent Lott's career began to tumble, Frist sprinted past the old guard to take his place.
Early on in last week's silent coup, he won key support from both ends of the caucus, from barely Republican Lincoln Chafee of Rhode Island to arch conservatives Don Nickles and James Inhofe of Oklahoma.
The past year has been pivotal in Frist's ascent. When the Senate faced the anthrax attacks in October 2001, Democratic leader Tom Daschle tapped Frist to help manage the crisis. As chair of the National Republican Senatorial Committee, he gained credit with his GOP colleagues by winning back the Senate.
"The Republican Party has backed into an extremely fortunate choice. Frist has a legitimacy on many of the Democratic issues, [especially] healthcare, that Lott did not," says Ron Rapoport, a political scientist at William and Mary College in Williamsburg, Va.
Frist manages relations with colleagues in much the same way he liked to run his operating room: calm, efficient, and congenial.
"Throwing instruments and humiliating others never made much sense to me," he writes in his 1989 autobiography, "Transplant." But, he adds, "the casualness was deceptive, a professional tone we all cultivated."
That professional tone has stamped every aspect of his political rise, starting with an early calculation that the way to Congress was to start a career outside Washington. As a young college intern, he asked his boss, Tennessee Rep. Joe Evins (D), his advice on how to get elected to Congress. "Go do something else - and it doesn't matter exactly what you do - but do it outside Washington and do it successfully," the congressman told him, as Frist notes in his book "Tennessee Senators, 1911-2001." "After 20 years of that something else," he said, "come back to Washington."
If you start the clock with his graduation from Princeton University in 1974, he hit that 20-year target dead on with his election to the Senate in 1994. A self- proclaimed citizen legislator, he promised to stay in the Senate only two terms, to end in 2006. (Capitol Hill observers note that leaves time for a rumored presidential bid in 2008.)
From his first year in the Senate, he used his background as a physician to help leverage legislation on healthcare, including medical savings accounts, patient privacy, and Medicare reform. A keystone of Frist's healthcare philosophy is a reliance on the private sector to provide medical benefits - especially payments for prescription drugs, which were not included in the original Medicare law.
His version of a patients' bill of rights allows people to sue their health maintenance organizations (HMOs), but only in federal court, and with damages capped at $500,000.
An opponent of abortion rights, Frist has emerged as a key voice on therapeutic cloning. As adviser to the White House, he helped craft the compromise that restricts federal funding to a limited line of embryonic stem cells.
While Frist is essentially untried in the tough procedural battles that are the daily life of leadership in a closely divided Senate, colleagues say he brings credibility, media savvy, and record of working across party lines that will help in that effort. "Bill Frist is a steady, thoughtful guy.... He will be a great leader, because he'll bring people together," says former Sen. Alan Simpson (R) of Wyoming.
Critics both inside and outside the party point to two areas of concern: his unusually close ties to a sitting president and his strong ties to the for-profit hospital industry, through the family business, the Columbia/HCA Healthcare Corp. "He will turn the Senate into a rubber stamp for the president," grumbles a leading conservative activist."
As a top recipient of campaign donations from drug firms, his moves on prescription-drugs will also be closely watched. One of the first tests may come early in the new session, when GOP moderates are expected to press the new majority leader to honor Lott's promise to strip from the new homeland security law a provision - drafted by Frist - that shields vaccine makers from lawsuits.